Toyota S, Nakamura N, Dan K
Department of Internal Medicine, Yokosuka Kyousai Hospital.
Rinsho Ketsueki. 2001 Jan;42(1):51-3.
A 30-year-old woman was admitted because of anemia and jaundice in 1999. She had been diagnosed as having idiopathic thrombocytopenic purpura (ITP) in 1996, but had shown no response to prednisolone (PSL). Subsequent splenectomy in 1998, followed by further treatment with PSL, had also been ineffective. On admission in 1999, the direct and indirect Coombs tests gave positive results, the cold agglutinin titer was high with anti-I specificity (IgM), and warm-type autoantibody (IgG) was positive. Autoagglutination of the patient's red blood cells was 3+ at 37 degrees C. A diagnosis of mixed-type autoimmune hemolytic anemia (AIHA) associated with ITP was made. Mixed-type AIHA occurring after splenectomy for ITP is very rare, only one case having been reported to date.
一名30岁女性于1999年因贫血和黄疸入院。她在1996年被诊断为特发性血小板减少性紫癜（ITP），但对泼尼松龙（PSL）无反应。1998年随后进行的脾切除术，继以PSL进一步治疗，也无效。1999年入院时，直接和间接抗人球蛋白试验结果呈阳性，冷凝集素效价高，具有抗I特异性（IgM），温型自身抗体（IgG）呈阳性。患者红细胞在37℃时自身凝集为3+。诊断为与ITP相关的混合型自身免疫性溶血性贫血（AIHA）。因ITP行脾切除术后发生的混合型AIHA非常罕见，迄今为止仅报道过1例。
